Not all audits are equal. Random sample audits and comprehensive audits represent entirely different approaches, goals, and outcomes. Even more challenging is sorting through the industry jargon to figure out what a vendor is offering in this industry.
We deliver a custom and comprehensive auditing process that is transparent to our clients. One audit scope cannot cover every possible goal that an employer could have, so we are open and honest with our clients about different audit approaches and how best to structure a claims audit to meets their specific needs. Unlike vendors who only offer one approach or who disparage different audit scopes or pricing arrangements, J. Graham Inc. can easily explain the pros and cons of various choices based on our experience of conducting them ourselves. We have a flexible approach that allows us to work with our clients in the most effective manner, and we do not pressure clients with a false sense of urgency. Our scope of work allows our clients to receive top value with a direct return on their investment.
Another difference in industry language is how claims auditors talk about technology. Claims audits are never a software solution. If a claims auditor could program a software to accurately find overpayments, every claims payer in the country would buy the logic to prevent errors in the first place!
People are key to the audit process. J. Graham Inc. is built on exceptional experience, exceptional expertise and exceptional people. We use database platforms and custom coding to allow us to apply our expertise across large data sets, but it takes real people with experience to perform a complete healthcare audit that can recover overpayments.
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